[Depression, deliberate self-harm and suicidal behaviour in adolescents engaging in risky and pathological internet use]

Reciprocal associations between shyness, depression, and Internet gaming disorder among Chinese adolescents: A cross-lagged panel study

While video games are one of the most common online entertainment activities, Internet gaming disorder (IGD) in adolescents is a critical issue that has become a widely raised public concern. This one-year longitudinal study examined the reciprocal associations between shyness, depression, and IGD symptoms in a sample of Chinese adolescents. A fully cross-lagged panel design was used, in which shyness, depression, and IGD symptoms were assessed at two time points with an interval of one year (T1 and T2). A total of 1,047 junior high school students (504 boys; 543 girls; mean age = 12.45 years) participated in the study. Cross-lagged analysis results indicated a significant positive correlation between shyness, depression, and IGD symptoms, as well as a dynamic and bidirectional relationship between them. Specifically, T1 shyness positively predicted T2 depression symptoms (β = 0.167, p < 0.001), T1 depression symptoms positively predicted T2 shyness (β = 0.141, p < 0.01), and T1 IGD symptoms positively predicted T2 depression symptoms (β = 0.073, p < 0.05). In addition to these findings, gender differences were identified in shyness (T1 and T2), IGD symptoms (T1 and T2), and depression symptoms (T2). The results also indicated that shyness and symptoms of depression could significantly positively predict each other over time, and IGD symptoms could significantly predict depression symptoms. However, depression symptoms could not significantly predict IGD symptoms over the one-year study period, and there was no significant two-way prediction between shyness and IGD symptoms. Thus, this study reveals possible reciprocal associations between shyness, depression, and IGD symptoms in Chinese adolescents and provides insights and suggestions for reducing online gaming addiction among adolescents from the perspective of shyness and depression.

DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial

BACKGROUND

Non-suicidal self-injury (NSSI) has become a substantial public health problem. NSSI is a high-risk marker for the development and persistence of mental health problems, shows high rates of morbidity and mortality, and causes substantial health care costs. Thus, there is an urgent need for action to develop universal prevention programs for NSSI before adolescents begin to show this dangerous behavior. Currently, however, universal prevention programs are lacking.

METHODS

The main objective of the present study is to evaluate a newly developed universal prevention program ("DUDE - Du und deine Emotionen / You and your emotions"), based on a skills-based approach in schools, in 3200 young adolescents (age 11-14 years). The effectiveness of DUDE will be investigated in a cluster-randomized controlled trial (RCT) in schools (N = 16). All groups will receive a minimal intervention called "Stress-free through the school day" as a mental health literacy program to prevent burnout in school. The treatment group (N = 1600; 8 schools) will additionally undergo the universal prevention program DUDE and will be divided into treatment group 1 (DUDE conducted by trained clinical psychologists; N = 800; 4 schools) and treatment group 2 (DUDE conducted by trained teachers; N = 800; 4 schools). The active control group (N = 1600; 8 schools) will only receive the mental health literacy prevention. Besides baseline assessment (T0), measurements will occur at the end of the treatment (T1) and at 6- (T2) and 12-month (T3) follow-up evaluations. The main outcome is the occurrence of NSSI within the last 6 months assessed by a short version of the Deliberate Self-Harm Inventory (DSHI-9) at the 1-year follow-up (primary endpoint; T3). Secondary outcomes are emotion regulation, suicidality, health-related quality of life, self-esteem, and comorbid psychopathology and willingness to change.

DISCUSSION

DUDE is tailored to diminish the incidence of NSSI and to prevent its possible long-term consequences (e.g., suicidality) in adolescents. It is easy to access in the school environment. Furthermore, DUDE is a comprehensive approach to improve mental health via improved emotion regulation.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00018945. Registered on 01 April 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018945.

[The prevalence and mental comorbidity of internet-dependent behavior in adolescents of Central Siberia]

OBJECTIVE

To study the prevalence of Internet addiction (IA) in adolescents in Central Siberia and the association of IA with mental health problems.

MATERIAL AND METHODS

The study included 2950 adolescents (44.7% boys and 54.3% girls), aged 11-18 years (mean age 14.5±1.3). Younger adolescents (11-14 years old) accounted for 52.4%, senior ones (15-18 years old) did 47.6%. The Chen scale (CIAS) with a cutoff level of 65 points was used to evaluate IA. The overall CIAS value of 27-42 points was regarded to be adaptive Internet use (AIU); 43-64 points being non-adaptive Internet use (NIU); 65 points and above were considered to be IA. Mental health was assessed using SDQ, which includes five scales: 1) prosocial behavior; 2) emotional symptoms; 3) behavior problems; 4) hyperactivity; 5) peer problems.

RESULTS

The prevalence of AIU is 50.3% (55.9% among boys and 45.6% among girls, p<0.01), NIU was found in 42.9% (38.9/46.3%, p<0.001), IA occurred in 6.8% (5.1/8.2%, p<0.001). The prevalence of IA among adolescents, aged 11-14 years old, was 5.9%, between the ages of 15-18 it was 7.8% (p=0.04). In the AIU group, emotional symptom** were observed in 5.1% of adolescents, behavior problems in 6.1%, hyperactivity in 3.6%; in the NIU group - in 14.9%, 11.7% and 9.4% of adolescents; in the IA group, there were 34%, 24% and 26% of adolescents, respectively. In terms of odds ratio (OR), the greatest effect size was observed for hyperactivity (OR=5.23, p<0.001) and emotional disorders (OR=4.85, p<0001).

CONCLUSIONS

The prevalence of IA is 6.8%. IA is more common in girls and increases with age. IA is associated with mental health problems, the greatest effect size is observed for hyperactivity and emotional disorders. The incidence of psychopathological manifestations increases depending on the degree of impairment in network behavior.

Internet addiction among college students in a Chinese population: Prevalence, correlates, and its relationship with suicide attempts

BACKGROUND

Internet addiction is common, but its relationship with suicide attempts is rarely reported among Chinese college students. This study aimed to investigate the prevalence and correlates of internet addiction among Chinese college students.

METHODS

A cross-sectional study was conducted among 8,098 college students in Hunan province, China. We collected the following data: demographic variables, suicidal behaviors, internet addiction (Revised Chinese Internet Addiction Scale), depression (Self-reporting Depression Scale), and anxiety (Self-Rating Anxiety Scale).

RESULTS

The prevalence of internet addiction was 7.7% in these Chinese college students. Logistic regression analysis showed that good relationship with mother (1.730 [1.075, 2.784]), good relationship with father (0.615 [0.427, 0.885]), family history of mental disorders (2.291 [1.122, 4.676]), anxiety (1.987 [1.382, 2.857]), depression (2.016 [1.384, 2.937]), suicidal ideation (2.266 [1.844, 2.784]), and suicide attempts (1.672 [1.258, 2.224]) were independent correlates for internet addiction, the adjusted R square for this model is 13.7%. Furthermore, the prevalence of suicide attempts among internet addiction participants was 21.4%, and anxiety (3.397 [1.058, 10.901]), suicidal ideation (26.984 [11.538, 63.112]), and suicide plans (8.237 [3.888, 17.451]) were the independent predictors for suicide attempts, the adjusted R square for this model is 51.6%.

CONCLUSION

Our results show that internet addiction is common among Chinese college students. In addition, suicide attempts are very common among internet addicts, suggesting that special measures and attention should be provided to these students according to risk factors to prevent their suicidal behavior.

Manifesto for a European research network into Problematic Usage of the Internet

The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.

Pathological Internet Use-An Important Comorbidity in Child and Adolescent Psychiatry: Prevalence and Correlation Patterns in a Naturalistic Sample of Adolescent Inpatients

Background

Few studies have examined the prevalence of problematic internet use (PIU) in young people undergoing inpatient treatment in child and adolescent psychiatry centers. The aims of our study were thus (a) to assess the frequency of comorbid PIU in a sample of adolescent psychiatric inpatients and compare it with a control group of nonreferred adolescents and (b) to gain insights into correlations between PIU and psychiatric comorbidities.

Methods

111 child and adolescent psychiatry inpatients (CAP-IP, mean age 15.1 ± 1.4 years; female : male 72.4% : 27.6%) undergoing routine psychodiagnostics were screened for the presence of PIU. The widely used Compulsive Internet Use Scale (CIUS) was chosen for this purpose. Prevalence rates of PIU were then compared to matched nonreferred control subjects from a school sample. Additionally, comorbidities of inpatients with PIU were compared to inpatients without PIU.

Results

Our inpatient sample showed a much higher prevalence of PIU than that found in previous populational samples of young people. Compared with a matched school sample, addictive internet use was 7.8 times higher and problematic internet use 3.3 times higher among our adolescent sample. PIU was significantly associated with characteristic patterns of psychopathology, that is, suicidality, difficulties in establishing stable and consolidated identity, and peer victimization.

Conclusion

PIU among adolescents undergoing inpatient psychiatric treatment is much more frequent than among their peers in the general population and is associated with specific patterns of psychopathology.

Diagnostik und Therapie von Suizidalität im Jugendalter: Das Wichtigste in Kürze aus den aktuellen Leitlinien

Zusammenfassung. Aufgrund der klinischen Relevanz von suizidalen Krisen, Suizidversuchen und Suiziden im Jugendalter wurde eine konsensusbasierte Leitlinie als Handlungsempfehlung erstellt. Jede Andeutung in Richtung Suizidalität muss ernst genommen werden. Suizidalität ist ein zentraler Bestandteil des psychopathologischen Befunds und Patienten sollten gezielt auf kurz- und langfristige Suizidgefährdung exploriert werden. Eine klinische Einschätzung des akuten Suizidrisikos ergibt sich aus einem vertrauensvollen anamnestischen Gespräch, der Erhebung von Risikofaktoren und dem Erfassen von psychischen Störungen sowie von Suchtmittelkonsum. Bei akuter Selbstgefährdung besteht eine Indikation zur stationären Behandlung, die zum Schutz des Patienten notfalls auch gegen dessen Willen umgesetzt werden muss. Eine adäquate Dokumentation ist unumgänglich. Nach einem Suizidversuch ist neben der fachärztlichen medizinischen Erstversorgung darauf zu achten, dass der Patient sich nicht schaden kann und rasch ein Konsil in der akutversorgenden Klinik erfolgt. Erstes therapeutisches Ziel ist die Reduktion der Suizidalität und ggf. das Wiedererreichen der Absprachefähigkeit. Für wiederkehrende Suizidgedanken ist ein Notfallplan zu erstellen. Zur Entlastung kann zusätzlich zu Gesprächsangeboten vorübergehend eine sedierende Medikation notwendig werden. Im Falle eines Suizids in einer Klinik sollte ein Handlungsleitfaden vorliegen, der die Zuständigkeiten und Abläufe genau regelt und festhält. Wirksame präventive Maßnahmen sind Schulungen von Multiplikatoren, Aufklärungskampagnen, Einschränkung der Verfügbarkeit von Suizidmethoden und die Einhaltung der Richtlinien zur Suizidberichterstattung.

Improving risk management for violence in mental health services: a multimethods approach

Background

Mental health professionals increasingly carry out risk assessments to prevent future violence by their patients. However, there are problems with accuracy and these assessments do not always translate into successful risk management.

Objectives

Our aim was to improve the accuracy of assessment and identify risk factors that are causal to be targeted by clinicians to ensure good risk management. Our objectives were to investigate key risks at the population level, construct new static and dynamic instruments, test validity and construct new models of risk management using Bayesian networks.

Methods and results

We utilised existing data sets from two national and commissioned a survey to identify risk factors at the population level. We confirmed that certain mental health factors previously thought to convey risk were important in future assessments and excluded others from subsequent parts of the study. Using a first-episode psychosis cohort, we constructed a risk assessment instrument for men and women and showed important sex differences in pathways to violence. We included a 1-year follow-up of patients discharged from medium secure services and validated a previously developed risk assessment guide, the Medium Security Recidivism Assessment Guide (MSRAG). We found that it is essential to combine ratings from static instruments such as the MSRAG with dynamic risk factors. Static levels of risk have important modifying effects on dynamic risk factors for their effects on violence and we further demonstrated this using a sample of released prisoners to construct risk assessment instruments for violence, robbery, drugs and acquisitive convictions. We constructed a preliminary instrument including dynamic risk measures and validated this in a second large data set of released prisoners. Finally, we incorporated findings from the follow-up of psychiatric patients discharged from medium secure services and two samples of released prisoners to construct Bayesian models to guide clinicians in risk management.

Conclusions

Risk factors for violence identified at the population level, including paranoid delusions and anxiety disorder, should be integrated in risk assessments together with established high-risk psychiatric morbidity such as substance misuse and antisocial personality disorder. The incorporation of dynamic factors resulted in improved accuracy, especially when combined in assessments using actuarial measures to obtain levels of risk using static factors. It is important to continue developing dynamic risk and protective measures with the aim of identifying factors that are causally related to violence. Only causal factors should be targeted in violence prevention interventions. Bayesian networks show considerable promise in developing software for clinicians to identify targets for intervention in the field. The Bayesian models developed in this programme are at the prototypical stage and require further programmer development into applications for use on tablets. These should be further tested in the field and then compared with structured professional judgement in a randomised controlled trial in terms of their effectiveness in preventing future violence.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Adaptation and Psychometric Evaluation of the Young Diagnostic Questionnaire (YDQ) for Parental Assessment of Adolescent Problematic Internet Use

Background and aims The surge of problematic Internet use in adolescents is a continuously growing problem across the globe. To our knowledge, to date valid questionnaire-based measurement of problematic Internet use is possible only by self-assessment. The objective for the present study was to adapt an established instrument for a parental assessment of adolescent problematic Internet use and to evaluate the psychometric properties of this questionnaire. Methods Data were collected from a representative German sample of 1,000 parents of adolescents aged between 12 and 17 years using a standardized questionnaire. To assess problematic Internet use, we adapted the established Young Diagnostic Questionnaire by rewording the items to survey a parental rating instead of a self-report ("Parental version of the Young Diagnostic Questionnaire," PYDQ). Additionally, we assessed the Internet usage time, parental monitoring, family functioning, school performance of the adolescent, and parent-adolescent conflicts. We conducted a confirmatory factor analysis based on the 8 items of the PYDQ modeled as categorical indicators and one latent factor using a robust weighted least squares estimator. We also calculated a reliability coefficient, the acceptance of the instrument, and performed correlation analyses. Results The unidimensional model showed excellent global goodness-of-fit (χ(2)/df = 1.65, RMSEA = 0.03, CFI = 0.99, TLI = 0.99) and satisfactory factor loadings (standardized values ranged from 0.60 to 0.77). We observed a reliability coefficient of 0.70, a good acceptance of the instrument, and the correlation analyses indicated the construct validity of the PYDQ. Discussion and conclusion The proposed PYDQ is a suitable instrument for parental assessment of adolescent problematic Internet use.

Risk Factors of Internet Addiction among Internet Users: An Online Questionnaire Survey

BACKGROUNDS

Internet addiction (IA) has become a major public health issue worldwide and is closely linked to psychiatric disorders and suicide. The present study aimed to investigate the prevalence of IA and its associated psychosocial and psychopathological determinants among internet users across different age groups.

METHODS

The study was a cross-sectional survey initiated by the Taiwan Suicide Prevention Center. The participants were recruited from the general public who responded to the online questionnaire. They completed a series of self-reported measures, including Chen Internet Addiction Scale-revised (CIAS-R), Five-item Brief Symptom Rating Scale (BSRS-5), Maudsley Personality Inventory (MPI), and questions about suicide and internet use habits.

RESULTS

We enrolled 1100 respondents with a preponderance of female subjects (85.8%). Based on an optimal cutoff for CIAS-R (67/68), the prevalence rate of IA was 10.6%. People with higher scores of CIAS-R were characterized as: male, single, students, high neuroticism, life impairment due to internet use, time for internet use, online gaming, presence of psychiatric morbidity, recent suicide ideation and past suicide attempts. Multiple regression on IA showed that age, gender, neuroticism, life impairment, internet use time, and BSRS-5 score accounted for 31% of variance for CIAS-R score. Further, logistic regression showed that neuroticism, life impairment and internet use time were three main predictors for IA. Compared to those without IA, the internet addicts had higher rates of psychiatric morbidity (65.0%), suicide ideation in a week (47.0%), lifetime suicide attempts (23.1%), and suicide attempt in a year (5.1%).

CONCLUSION

Neurotic personality traits, psychopathology, time for internet use and its subsequent life impairment were important predictors for IA. Individuals with IA may have higher rates of psychiatric morbidity and suicide risks. The findings provide important information for further investigation and prevention of IA.

Der Zusammenhang von Mobbingerfahrungen, Copingstilen und pathologischem Internetgebrauch bei Jugendlichen

Fragestellung: In der vorliegenden Studie wurde untersucht, ob ein Zusammenhang zwischen pathologischem Internetgebrauch, Mobbing und Copingstilen bei Jugendlichen mit Mobbingerfahrungen besteht. Methodik: Im Rahmen einer europäischen schulbasierten Studie (SEYLE) wurde eine repräsentative Querschnittsuntersuchung an 1357 Schülern aus Heidelberg und Umgebung durchgeführt (710 weibliche/647 männlich Jugendliche; mittleres Alter 14.7; SD 0.8). Pathologischer Internetgebrauch wurde mit dem Young Diagnostic Questionnaire erhoben. Mobbing wurde in verbales, körperliches Mobbing und Mobbing in der Beziehung unterteilt. Hinsichtlich der Copingstile wurden aktives Coping, Vermeidung, Hilfe suchen und sonstige Strategien unterschieden. Als Kovariate wurde die psychische Symptombelastung mittels Strengths and Difficulties Questionnaire erfasst. Ergebnisse: 4.8 % der Schüler wiesen einen pathologischen Internetgebrauch auf, 14.4 % zeigten einen problematischen Internetgebrauch. Insgesamt berichteten 52.3 % der Jugendlichen über Erfahrungen mit Mobbing (38.7 % verbales Mobbing, 19.8 % körperliches Mobbing, 34.1 % Mobbing in der Beziehung). Es bestand ein signifikanter Zusammenhang von Mobbingerfahrungen und pathologischem Internetgebrauch, der zum Teil durch die psychische Symptombelastung erklärt werden konnte. Hinsichtlich der Copingstile bei stattgefundenem Mobbing bestand kein signifikanter Unterschied zwischen Schülern mit normalem, problematischem und pathologischem Internetgebrauch. Schlussfolgerungen: Aufgrund des Zusammenhanges zwischen Mobbing, psychischer Symptombelastung und pathologischem Internetgebrauch sind in der Zukunft schulbasierte sowie familienbezogene Präventionsmaßnahmen und evaluierte Therapieprogramme erforderlich.

Internet addiction and its correlates among high school students: a preliminary study from Ahmedabad, India

PURPOSE

Internet addiction (IA) is an upcoming and less researched entity in psychiatry, especially in low and middle income countries. This is the first such effort to study IA amongst Indian school students of class 11th and 12th and to find its correlation with socio-educational characteristics, internet use patterns and psychological variables, namely depression, anxiety and stress.

METHODS

Six hundred and twenty one students of six English medium schools of Ahmedabad participated, of which 552 (88.9%) who completed forms were analyzed. Young's Internet Addiction Test and 21 item Depression Anxiety and Stress Scale were used to measure IA and psychological variables respectively. Logistic regression analysis was applied to find the predictors of IA.

RESULTS

Sixty-five (11.8%) students had IA; it was predicted by time spent online, usage of social networking sites and chat rooms, and also by presence of anxiety and stress. Age, gender and self-rated academic performance did not predict IA. There was a strong positive correlation between IA and depression, anxiety and stress.

CONCLUSIONS

IA may be a relevant clinical construct, and needs extensive research even in developing nations. All high school students suffering from depression, anxiety and stress must be screened for IA, and vice versa.

[How do adolescents view non-suicidal self-injury? Differences between affected and non-affected adolescents in a school sample]

Despite the growing number of epidemiologic studies about the prevalence of non-suicidal self-injury (NSSI), little knowledge exists regarding the way adolescents view NSSI, whether differences in the attitudes towards NSSI between affected and non-affected adolescents exist and whether the acquaintance with adolescents engaging in NSSI influence one's attitudes towards self-injury? In an epidemiological study of non-suicidal self-injury, we assessed the attitudes of 447 ninth grade students (age 15 years SD = 0.7, 52% male) NSSI using a self-constructed questionnaire with three factors. Sixty one (13.6%) pupils reported that they had intentionally injured themselves once in their life time. 43% (n = 179) indicated that they discuss the topic with others, though over half of these pupils 54% (n = 98) stated feeling burdened by discussions with friends affected by NSSI. Comparisons between affected and non-affected adolescents revealed that adolescents who had never exhibited NSSI tend to believe that NSSI is mostly interpersonally motivated. Moreover, the adolescents affected by NSSI assessed the emotional reaction as more appropriate than non-affected adolescents. This should be considered in the design and refinement of inpatient treatment concepts. Our results suggest focusing on intrapersonal motives in psychotherapeutic sessions and reducing interpersonal motives for self-injurious behaviour through the establishment of clear and transparent milieu therapeutic structural conditions.